Serum HBV RNA is associated with liver fibrosis regression in HBeAg‐positive chronic hepatitis B patients treated with nucleos(t)ide analogues

Abstract Noninvasive methods for assessing hepatic fibrosis are clinically necessary. This study aims to explore HBV markers correlated with liver fibrosis and capable of diagnosing significant fibrosis and predicting fibrosis regression. Seventy‐four HBeAg‐positive chronic hepatitis B (CHB) patients were enrolled and started on entecavir or adefovir therapy. Serum HBV RNA, HBV DNA, HBsAg and hepatitis B core‐related antigen (HBcrAg) levels were measured at baseline and during treatment. Liver fibrosis was assessed at baseline and month 60 by liver biopsy. Fibrosis regression was defined as Ishak fibrosis score decreased ≥1‐point. At baseline, HBsAg, HBcrAg and HBV RNA levels had a stronger correlation with Ishak fibrosis score ( r = −.441, p = .002; r = −.469, p = .001; r = −.398, p = .001) than APRI and FIB‐4 ( r = .321 p = .006; r = .371, p = .001). HBsAg >4 log 10 IU/ml plus HBcrAg >7 log 10 IU/ml or HBsAg >4 log 10 IU/ml plus HBV RNA >5 log 10 copies/ml exhibited the same excellent diagnostic ability for significant fibrosis with the AUROC of 0.857. After 60 months of antiviral treatment, 66.7% of patients who suffered significant fibrosis at baseline achieved fibrosis regression, and an HBV RNA decline from baseline to month 6 greater than 0.63 log 10 copies/ml could predict the fibrosis regression at month 60. In conclusion , serum HBsAg, HBcrAg and HBV RNA are potential markers for predicting significant liver fibrosis. HBV RNA measurement would be particularly useful for monitoring hepatic fibrosis changes in HBeAg‐positive CHB patients.